HEALTH ADVISORY

SUMMARY:

• A suspected measles case has been identified in Northern Virginia associated with international travel. The suspect case is known to have visited a health care facility in Fairfax County during their infectious period.

• The Fairfax County Health Department is conducting an investigation and is contacting people known to have been exposed in the County. See  VDH press release for the known exposure sites and times.

• Individuals directly exposed to this case may develop signs and symptoms as late as 6/25/2019.

SUGGESTED ACTIONS:

• Maintain an increased index of suspicion for measles in clinically compatible cases at all times and particularly if a patient presents with fever and rash and has history of being at one of the exposure sites listed in the press release during the period of concern.

• Take the following actions for a patient with fever and a rash that you suspect is measles.

• Immediately triage the patient; do not allow such patients to remain in your waiting area.
• Place a surgical mask on the patient as soon as possible.
  • If you are aware that a suspect measles patient will be arriving at your facility, consider evaluating the patient outside (e.g., in the parking lot), if feasible, to minimize exposure to others. If the patient enters the building, ensure that the patient is masked before doing so.
  • If referring a suspected measles case to another health care facility, notify the facility before sending the patient so that appropriate infection control measures can be implemented at the receiving facility.
     
• Place the masked patient in a private, negative pressure room if available, or a room with a closed door. This room should not be used for 2 hours after the suspect measles patient leaves.
• Use standard and airborne precautions.
• Only health care workers with immunity to measles should work with the patient.
• Measles is an immediately reportable disease. Contact the Health Department’s Communicable Disease/Epidemiology Unit immediately at 703-246-2433 (normal business hours) or 703-409-8449 (evenings and weekends) to report the suspected case and for guidance on testing and infection control measures.

• Ensure that all patients, particularly those traveling internationally, are vaccinated against measles.

ADDITIONAL INFORMATION:

Measles is a highly infectious viral disease with an incubation period of approximately 10 days (range 7 – 21 days) from exposure to rash onset. Patients with measles are considered infectious from 4 days before to 4 days after rash onset. Transmission is primarily person-to-person by large respiratory droplets. Airborne transmission by aerosolized droplets has been known to occur within shared air space for up to 2 hours after an infectious person with measles has occupied that space.

The Centers for Disease Control’s (CDC’s) clinical case definition for measles is an illness characterized by ALL of the following:

1. generalized rash lasting > 3 days,
2. temperature > 101°F (38.3°C),
3. cough, coryza, and/or conjunctivitis.

The laboratory criteria for measles include ANY ONE of the following:

1.  positive IgM serologic test for measles,
2. significant rise in measles IgG antibody,
3. isolation of measles virus from a clinical specimen, or
4.  detection of measles-virus specific nucleic acid by polymerase chain reaction.

In general, persons may be presumed to be immune to measles if they have documentation of two doses of measles vaccine, laboratory evidence of immunity to measles, documentation of physician-diagnosed measles, or were born before 1957. Persons who are not immune should be given MMR vaccine or immune globulin according to Advisory Committee on Immunization Practices (ACIP) recommendations.

Individuals who work in health care facilities in any capacity are at increased risk of exposure to measles. To ensure staff are immune to measles, they must have documentation of two doses of measles vaccine or laboratory evidence of immunity to measles. Birth before 1957 is not acceptable evidence of immunity for health care providers. Susceptible personnel who have been exposed to measles should not have contact with patients or be in a health care facility from the 5th through the 21st day after exposure, regardless of whether they received vaccine or immune globulin after the exposure.

Children traveling internationally or who have been exposed to a case can be given measles vaccine as early as 6 months of age. These children should then receive a measles vaccine at 12-15 months of age, at least 28 days after the initial dose.

Additional information about measles and measles vaccination is available at the CDC website at http://www.cdc.gov/measles/index.html.